New info for Tricare Insurance users.

Offerocker · Post by **Offerocker** » Fri Jun 23, 2006 6:46 am

OwlCreekObserver wrote:Which just proves my long held belief that the only thing the feds are capable of doing well is defense.

I cannot help but comment...they seem to be best at defending themselves!

dllfo · Post by **dllfo** » Fri Jun 23, 2006 12:50 pm

Linda, sorry to hear about that.

I only ask that Tricare be held accountable. AND that they put their own regs on the internet so WE can read them too.

Like...how long until you can get another machine? I don't need one, but just like to know what my "rights" are.

IF THEY WOULD HAVE POSTED THEIR MANUALS ONLINE, YOU COULD HAVE READ THE CHANGE, AVOIDING A HASSLE.

I sort of agree they spend a lot of time covering their own rear ends. This is part of why I ALWAYS ask for their name and where they work. Dallas, LA or
whereever. This lets them know I can find them again. OR their boss can.

WHAT I AM STILL FRUSTRATED OVER IS THEM TELLING ME I DON'T NEED AN APPROVAL FOR UNDER A CERTAIN DOLLAR AMOUNT. I TELL THEM THE MASK THEY GAVE ME HAS RUBBED MY NOSE RAW AND WANT ANOTHER MASK. THE TRICARE GUY WHO JUST TOLD ME I DON'T NEED AUTHORIZATION, TURNS AROUND AND TELLS ME I NEED AUTHORIZATION FOR A $100 ITEM.
GRRRRRRRRRRRRRRRRRRRRRRRRRRRRR............

Very frustrating.

Well folks, it is noon. Nap time. HEY...not nice to clap and cheer....

waiterc · Post by **waiterc** » Fri Jun 23, 2006 1:26 pm

Tricare is my primary insurance and I also work for a major hospital in the southern region. Let me tell you what we do in my hospital and what my DME did for me.

I saw my doctor on Monday to get the results of my sleep study. On Tuesday evening my DME was at my house with my equipment and APPROVAL from TRICARE. I received my hard copy approval from TRICARE in the mail on Thursday. This all happened in February of this year.

Earlier this month my DME called to ask if I would like to trade my Respronics Plus 2 for the M series Pro. He said because TRICARE was still renting and the cost of the units was comparable, he would be glad to swap. Sounded good to me and the swap was made.

Last week I had my followup with my sleep doctor and we talked about an APAP. He said if that was what I wanted to go ahead. The next day my DME gave me a Respironics APAP to try for a couple of weeks to see if I liked it. If I do, he will take back the Pro and replace the APAP with an M series APAP when they come out. No problems, no money difference!

I should at this time mention that in addition to TRICARE I have ASI which is a supplement paid for by my employer that pays what TRICARE does not pay.

I also called TRICARE on the renting vs purchase and was told that TRICARE always rents until the cost of the rental exceeds the cost of the device. At that point, at least with the DMEs here, all payments stop and the equipment is owned by the customer. I also asked about changing equipment. I was told if the Doctor ordered it, they would pay for it.

FYI this is also the DME that provided me with the software and reader at no cost.

I guess when you find a good DME you are lucky, if you don't you can have real problems.

Linda3032 · Post by **Linda3032** » Fri Jun 23, 2006 2:46 pm

Waiterc,

You must be in Tricare Prime based on what you wrote, "TRICARE always rents until the cost of the rental exceeds the cost of the device". That might be true for Prime, but it is not true for Standard.

I believe that's where so many problems and confusions come from -- the different levels of Tricare.

I am in Standard, so what I write only pertains to Standard's rules. I don't have to rent. I can buy online and submit my own claims for reimbursement. I've bought two Remstar Auto's (same coding) a little less than 3 years apart. I can get another machine -- as needed. No prior approvals. No DMEs required.

All that said, my problem with my March (within the 3 month change-of-rules) fiasco has almost been straightened out. My doctor had to write and backdate a letter of "medical necessity" (the new prescription didn't count - lol), and my claim was paid.

However, Tricare screwed up and coded it as a rental. So it took another phone call from me today to get them to pull my paperwork and see that it was an outright purchase. No problem, they will cut an additional check. My new machine only cost $614 which is almost half of what Tricare allows for code E0601. So I saved them bunches of money.

And I also have ASI as a Tricare supplement. So they pick up my 25% co-pay.

Linda3032 · Post by **Linda3032** » Fri Jun 23, 2006 3:01 pm

Tricare and Medicare
I don't know how many of you Tricare insured are also on Medicare, but this is a sad "let's screw our veterans one more time" situation.

My husband, who put 21 years in the USMC, just turned 65 and was forced to sign up for medicare. I say forced because Tricare for Life (for those over 65) won't kick in unless he signs up for Medicare Part B.

So in order to get the benefit (which was promised by the US Government for life), he had to sign up for part B....

Now, you assume that since he now gets Medicare in addition to Tricare, that his out-of-pocket costs would go down. NOT.. It is actually costing him more because now he has to pay for part B in order to even be eligible for Tricare... What a crock of you-know-what ... And, you can no longer use ASI as a Tricare supplement -- they automatically drop you at age 65. So forget that.

Anyway, just wanted to vent. As I said, just one more thing to show our veterans that all their years of dedicated service doesn't mean much to our government.

Linda3032 · Post by **Linda3032** » Sat Jun 24, 2006 3:22 pm

New Info (in case you didn't know)

Yes, it would be great if Tricare could/would publish their rules and regulations, for all 3 levels, on the web. However, I just found out something that could have avoided some problems. And this can help you also.

You don't have to get the name of the person that told you "wrong information". Get it in writing and cover your u-know-what.

Go to the Tricare site and set up an account with your name and password. Tricare will mail you a Security Key Code (takes about a week to get the letter). Enter their code and you have instant access to all your Tricare claims, EOBs, etc. Here is the site:

http://www.tricare.osd.mil/questions_tma/default.aspx

But, what I like is the fact that you can "contact them, ask a question, and they will respond to you in writing".

An example is that I contacted them yesterday (via phone)regarding the "claim from hell". The woman I spoke with said this and that, etc., and that she would contact the DME dept to do an adjustment, etc, etc, etc. We all know the drill.

Today, I got my security key letter, so I pulled up my file and the DME dept had already corrected my filing and it was in the computer - including the EOB showing how much the check is for. Wow.

So, if you set up an account, you can email them questions. A copy of your question and their answer goes into your Tricare mail account so you have a record of it. If you have any problems, at least you have proof of what was said. Sounds good to me. You might want to set up your account for future use.

OwlCreekObserver · Post by **OwlCreekObserver** » Sat Jun 24, 2006 4:20 pm

Yeah, I checked my account info yesterday and there's no entry yet for the DME stuff. I really have no idea how or when the DME bills, since part of the stuff (like mask and hose) is a purchase and the rest (CPAP machine and humidifier) is leased. I think they'll probably bill it all at once, probably somewhere around the end of the month.

dllfo · Post by **dllfo** » Sun Jun 25, 2006 11:02 am

Linda...Thanks for the info. Now that YOU said it, I vaguely remember something about doing that. I am out of town now, but I could apply and have the letter waiting at home.

And I saw the "Rural Arkansas" comment. Linda, I know you are too young to remember this, but they used to make movies in northwestern Ark. about a couple called "Ma and Pa Kettle" ......are they kin to you? Check Google, they
are probably your great aunt and uncle.

I am registered with Tricare Dental, but not the regular tricare. I will go there to see if my password, etc. works on both sides.

Linda3032 · Post by **Linda3032** » Sun Jun 25, 2006 2:14 pm

dllfo wrote: And I saw the "Rural Arkansas" comment. Linda, I know you are too young to remember this, but they used to make movies in northwestern Ark. about a couple called "Ma and Pa Kettle" ......are they kin to you? Check Google, they
are probably your great aunt and uncle.

Oh ya, everyone in Arkansas knows Ma and Pa. Actually, I think all of us are first cousins of first cousins who were first cousins.

(New picture just for you, Dave)..

jeepdoctor · Post by **jeepdoctor** » Sun Jul 16, 2006 8:24 pm

I don't know how my CPAP gig with Tricare is going to work out since I haven't received and EOB for either the miserable sleep doc's bill or for Lincare's bill. I do know that I was told by a Tricare claims rep that their network deal with Lincare for ANY heated CPAP is $ 1,403. Since Lincare gave me a $ 545 machine (CPAP.com price), this could be a major sticking point in the future. (I am Tricare standard).

I want to say a few words in defense of Tricare South. I retired from ConocoPhillips in December 02 with 18 months of COBRA insurance. At about COBRA month 14, I turned 60 and got my gray ID card. The coordination of benefits deal was a real hassle so I dropped my COBRA insurance. I forget who COP used as their insurance carrier, but I have to tell you that dealing with Tricare has been seemless compared to dealing with COP's insurance carrier. In fact my eye doc's office folks (he is network Tricare, as well as being a heck of a fine doctor and a super-fine person) told me that Tricare is MUCH BETTER to deal with than the COP insurance carrier is (or was at the time). Up until now I have sung the praises of Tricare. Admittedly there were a few potholes in the road when Tricare South switched contractors. Other than those few potholes, I have nothing but praises for Tricare.

My CPAP gig may be the opening of a new chapter in my relationship with and my feelings about Tricare. The network deal that Tricare has with Lincare on CPAPs looks like a real honest-to-God fraud/waste/abuse situation to me. In addition, two members of this forum have told me that I don't need a doc's verification of need, or whatever it is called to buy a CPAP machine. They tell me that I can buy a machine, send the prescription, reimbursement form and invoice to
Tricare and voila, a reimbursement for 75% of the cost arrives in the mail a few weeks later. However, a Tricare claims rep told me two weeks ago that I need the doc's verification to Tricare. So Wednesday, I will be back on the telephone with Tricare, trying to figure out which end is up.

Linda3032 · Post by **Linda3032** » Sun Jul 16, 2006 9:26 pm

JeepDoctor, as I told you privately, Tricare Standard beneficiaries don't need to get pre-approval.

I am in Tricare South also, and even though I fell into that "3 months of hell" fiasco above, I just got 75% reimbursement from Tricare. I bought from cpap.com (I faxed them a copy of my prescription). I mailed my itemized invoice, a claim form, and a copy of my prescription to Tricare. And I got reimbursed. It's really cut and dried.

I never meant to bad-mouth Tricare. I've had very straight forward dealings with them. And actually, I think we Standard people get less hassle than the Primes do.

And, we don't have to rent first. Yippee.

And like I mentioned, be sure to sign up for your online account. It takes about 10 days to get your security code. It's nice seeing your claims online, and know it has been processed and how much the check is being cut for.

jeepdoctor · Post by **jeepdoctor** » Mon Jul 17, 2006 5:39 am

Linda, Thank-you, thank-you for your advice. I went to the Tricare South web site and couldn't find the web page for online account signup. So I went to the site where one can ask questions ( http://www.tricare.osd.mil/questions_tma/default.aspx )and asked them to send me detailed instructions for signing-up. When I receive the instructions, I will post them.

OwlCreekObserver · Post by **OwlCreekObserver** » Mon Jul 17, 2006 6:49 am

jeepdoctor wrote:Linda, Thank-you, thank-you for your advice. I went to the Tricare South web site and couldn't find the web page for online account signup. So I went to the site where one can ask questions ( http://www.tricare.osd.mil/questions_tma/default.aspx )and asked them to send me detailed instructions for signing-up. When I receive the instructions, I will post them.

I believe that North & South regions share the same site: http://www.mytricare.com/internet/tric/tri/tricare.nsf

There's a registration button on the left side.